“We received a desperate phone call from someone who had negotiated a deal: 40 thousand euros to have their kidney extracted and sold. ‘Mr Ferrari’ – this is what we’ll call him – runs a family business which fell into the hands of loan-sharks after going through some hard times. Unable to make his payments, he began exploring the ‘dark web’ in an attempt to uncover some way of staving off reprisals; not just a dark web, but a deep web, too, one which can lead to getting tangled up in things that may prove too difficult to escape from. And Mr Ferrari was offered what he thought was the solution: selling his kidney. He accepted. The agreed figure was 40,000 euros, to be paid in bitcoins. The extraction took place in Italy, but in the end he was cheated, receiving only the 10,000 euro guarantee paid before the operation. But he lost his kidney. This all took place in Italy, a year and a half ago.”
These are the words of the lawyer Marco Martello, from the non-profit organisation Emergenza Legalità Onlus, which helps victims of usury and extortion. He contacted EstremeConsequenze to tell us about the criminal investigation currently underway to throw the lid open on this most heinous of crimes, but considering the delicacy of the issue, he requested that EstremeConsequenze maintain the anonymity of both the victim and of the public prosecution office carrying out the inquiry. We can, however, confirm that the matter is now being investigated on a national level: when EstremeConsequenze asked Dr. Alessandro Nanni Costa, the director of the CNT (the Italian National Transplant Centre), to comment, he said he had alerted the relevant authorities at the Ministry of Health. Dr. Nanni Costa underlined that this was “a singular case, which makes it even more serious, as in Italy the trafficking of organs is inexistent”. He continued: “There are very stringent controls. The norms are severe. The laws are clear. In addition, an organ extraction and a subsequent transplant are certainly not simple procedures, nor can they be done cheaply. There are specific processes to follow, and a national register to cross-reference information. Preliminary examinations need to be carried out. There are carefully controlled waiting lists. We know – and we have long known – that this kind of trafficking exists in many parts of the world, and we work to combat it. But this phenomenon does not exist on Italian soil. So for us, this news means a serious crime has been committed, and we will do our utmost to follow the case.”
The president of AIDO (Italian Association of Organ Donors), Flavia Petrin agrees: “There is no evidence of any illegal trafficking of organs in Italy; some reports made in the past few years were investigated by the public prosecution, and turned out to be false. The system of donations and controls works, even if there is admittedly a problem with long waiting lists.”
Martello confirmed to EstremeConsequenze that it is the sole case reported to his organisation that has revealed itself to be genuine after some investigation (“I have personally seen the scar on Mr Ferrari’s abdomen”), but declares that “many other people have come forward saying that they would be willing to sell an organ in order to escape dire financial straits.”
Some screenshots testifying to his words.
Selling an organ abroad, especially a kidney, might seem like an arduous task, but it turns out to be easier than thought: EstremeConsequenze even managed to strike a deal with a clinic in India, using everyday search engines on the web. We received a reply within a few hours of contacting them, and the price agreed upon was 120,000 euros, to be paid in two installments, travel excluded.
This was the exchange of emails:
But it’s one thing to try and sell an organ abroad (traffickers can be sentenced with up to 12 years imprisonment in Italy), quite another to understand if this phenomenon exists in Italy. And there is another side to this crime, one that stretches the imagination in its atrocity: the extraction of organs of people who have not given their consent. EstremeConsequenze is still investigating this barbaric aspect.
On November 6th of this year, Martello took part in a conference in Salerno, Italy, on the illegal traffic of organs in the country, organised by the associations “Indiani d’Occidente” and “Libera Salerno”. It was the first time Libera Salerno – which usually deals with Mafia problems – had ever officially taken part in a discussion on the issue of organ trafficking. The Regional Councillor for Campania, Enzo Maraio, also took part in the conference, announcing that a proposal is in the pipeline to set up a regional observatory on organ trafficking, which would both inform citizens and study the phenomenon; he hopes that it will be approved before the end of the legislature in May 2019. If approved, this would be a nationwide first: no other regional government in Italy has ever founded an observatory to analyse the illegal trafficking of organs. He talks about the nexus between organised crime and organ trafficking: “Today, organised crime’s tentacles have reached organ trafficking, which is in turn linked to people trafficking. I proposed this new law because little is known about this phenomenon, defined by the International Labour Organization (https://www.ilo.org/global/lang–en/index.htm) as ‘hard to see, harder to count’. It is hard to find proof, hard to follow up reports. It remains invisible, underground. And those involved – on either side of the spectrum – do not speak up. In Italy, people seem to think of it as an urban myth, but even students of Economics 101 know that if there’s a supply, there must be a demand. It is vital that we try to understand more, especially in a region like ours.”
The founder of the association “Indiani d’Occidente”, which has for years been exploring this issue, is Santa Rossi, who explains to EstremeConsequenze why light needs to be shed on such a seemingly distant problem: “We have always thought that problems like this are light years from us, and that this inhumane traffic only takes place in certain foreign countries, that at most, maybe a few Italians take part in ‘transplant tourism’. But that’s not the way things are. Indiani d’Occidente – my own personal battle – began 11 years ago when my husband died while on a waiting list to have a liver transplant. It all happened one afternoon, I remember every detail of that afternoon. It was May 10th, 2007.
“I was heading into the parking lot of the Cardarelli hospital in Naples, where my husband was a patient. A stranger grabbed me by the shoulder from behind and warned me not to turn around. He said I could help save my husband. That he had a new liver for him. He even knew my husband’s blood type, he knew his entire medical history. He said he could help accelerate things and save him. All this for 250,000 euros. I spoke to my husband, and we came to a decision: not only would we refuse, but we would begin a battle to end this phenomenon. Sadly he died 20 days later, but this is a battle I have carried forward right to this day.
“There are people who are willing to deprive themselves of one of their vital organs, due to financial problems,” she continued. “We know full well that this activity requires structures with specialised equipment and the collaboration of medics. There were rumours of a clinic in Rome and another two in Sicily. Over the last few years, the public prosecution has gathered evidence of the exportation of organs from migrants who have given their livers to pay for their passage. There are investigations still underway, but the problem is that nobody is reporting the crime; not in the people’s countries of origin, and of course no migrant who has voluntarily given up an organ would ever press charges. There has always been pressure on me to ‘gather proof’. I began this battle ten years ago with the CGIL, one of the country’s main unions, and together we tried to get people to report their experience of these matters. A lot of people phoned in. I’m willing to speak up for people who are struggling and who tell us their stories. The most unsettling phone call wasn’t from someone telling me that they had been trying to sell a kidney, but from a mother whose son was on a transplant waiting list – she was furious with me: “I couldn’t care less about your battle,” she screamed. “All I care about is saving my son, and I’m willing to try anything. All you lot do is cause trouble!”
Organised crime has a finger in many pies: drugs, arms smuggling, the traffic of people. And in organ trafficking too. And what worries us is the trafficking linked to prostitution, mainly run by the Nigerian mafias. There are no scruples, unheard of violence is used. We know these women have to repay a debt. But we don’t know how they do it. There are women forced into prostitution in Campania, who then seem to disappear off the face of the earth. What happens to them?
“Donate, donate, donate”
“There is one thing I really want to make clear: we are in favour of organ donation, and we fight this battle to convince people to become donors. And we are donors, Italians are traditionally a people who donate their organs. But the laws do not help. Italy needs a law like the one in France, which has an opt-out law: if you don’t expressly state that you don’t want to donate, it is presumed that you will. While today in Italy, people have to give their consent, they have to opt in, and the information about donating is inadequate. But we need more donors, we need an opt-out system and for the waiting lists to be slashed.”
The Salerno branch of Libera has been fighting for years against criminal trafficking of all sorts, and for the first time they turn their attentions to this very specific and atrocious type of trafficking.
“Indiani d’Occidente has been on the frontline in the battle against illegal organ trafficking,” Anna Garofalo tells us from the Salerno offices of Libera. “And for the first time Libera is joining them in the fight. When we talk about the Mafia, we also talk about this issue, both national and international. We want to highlight one thing: people’s perception of how much organised crime affects their life is low, but in truth, organised crime is far more diffused than people imagine. We at Libera feel it’s vital to examine every aspect of organised crime, in order to build a profound awareness of its mechanisms. And the traffic of people and of organs is an issue that needs to be examined, a crime that is mainly carried out by foreign crime syndicates. We work closely with ‘Indiani d’Occidente’ to this end. Libera Salerno and Libera Campania are especially alarmed about trafficking young women for prostitution, and all its relative consequences.”
Organ trafficking was first mentioned by the World Health Organization in 1987, and on May 20th, 2010, the WHO reaffirmed its dedication to eradicating this phenomenon, with the publication of Resolution WHA63.22. According to WHO estimates, there are approximately one million organ transplants carried out per year (the majority are kidney transplants, which are estimated at making up 75% of the illegal trade), with a little over 10% of that total (120,000) being considered absolutely necessary.
In the document, the WHO Member States strongly condemn “the buying of human body parts for transplantation and the exploitation of the poorest and most vulnerable populations and the human trafficking that results from such practices”.
The Vatican recently added its voice of support to this condemnation: in February this year the Pontifical Academy of Sciences organised a conference to talk about illegal organ trafficking and transplant tourism (see attachment). Various countries in Asia were flagged, as was Mexico and other areas of Latin America, Egypt, Pakistan and India. The main recipients of donors were from Canada and the US, Western European nations; then Australia and the Gulf states, especially Saudi Arabia, Kuwait and the United Arab Emirates. Iran has even gone so far as to legalise the sale of human organs. A statement published by the Vatican after the event affirmed: “We hope this Summit will create a top-down and bottom-up movement in society, to raise awareness of the extension and seriousness of this modern challenge and lay the groundwork for moral and appropriate solutions based on human dignity, freedom, justice and peace.”
Poverty, unemployment and the lack of socio-economic opportunities are the factors that create vulnerability to organ trafficking and to human trafficking aimed at organ extraction. The needy are easy prey for traffickers who persuade them to sell an organ in the desperate attempt to improve their sort. At the same time, desperate patients are willing to pay vast sums for an organ that could save their lives, unaware of the consequences that a transplant with a lucrative financial goal behind it could have on their health.
It is not only traffickers that oil the wheels of this market: unscrupulous medical staff are also fundamental players in the mechanism of organ trafficking, as transplant tourists travel to unauthorised clinics for their surgery.
There are a number of internationally agreed measures in place which define, condemn and penalise such pratices: the UN Palermo Protocols, against people trafficking, the Council of Europe Convention on Action against Trafficking in Human Beings and the Council of Europe Convention against trafficking in Human Organs.